Classica Sinica Medica

Above the Diaphragm

上膈

Shàng gé

A short, entirely clinical chapter on two obstructions at the diaphragm. The first, from qi, is dismissed in a sentence: food goes in and comes straight back. The second, from worms, is the subject: food stays a whole day and night before it leaves. The mechanism is a chain of cause and effect — irregular food and emotion chill the juices, the chilled worms mass at the lower opening, the stomach and intestines swell, the guarding qi fails, evil qi settles, and a sore forms that constricts the passage. The treatment is described step by step: press and locate, needle shallowly then deeper, no more than three passes, then apply heat daily until the sore breaks, keep the prohibitions, stay quiet so the qi can move, and finish with salty and bitter flavors to move the grain down.

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黃帝曰：氣爲上膈者，食飲入而還出，余已知之矣。蟲爲下膈，下膈者，食晬時乃出，余未得其意，願卒聞之。 黄帝曰：气为上膈者，食饮入而还出，余已知之矣。虫为下膈，下膈者，食晬时乃出，余未得其意，愿卒闻之。
Huáng Dì yuē: qì wéi shàng gé zhě, shí yǐn rù ér hái chū, yú yǐ zhī zhī yǐ. chóng wéi xià gé, xià gé zhě, shí zuì shí nǎi chū, yú wèi dé qí yì, yuàn zú wén zhī.
黄帝说：气为上膈的，饮食入而还出，我已经知道了。虫为下膈，下膈的，食物一昼夜才出，我还没有明白它的意思，希望听个究竟。
The Yellow Emperor said: When qi forms an obstruction above the diaphragm, food and drink enter and come back out — I know that already. When worms form an obstruction below the diaphragm, food comes out only after a full day and night, and I have not grasped the meaning of it. I wish to hear it to the end.
歧伯曰：喜怒不適，食飲不節，寒温不時，則寒汁流於腸中，流於腸中則蟲寒，蟲寒則積聚，守於下管，則腸胃充郭，衛氣不營，邪氣居之。 歧伯曰：喜怒不适，食饮不节，寒温不时，则寒汁流于肠中，流于肠中则虫寒，虫寒则积聚，守于下管，则肠胃充郭，卫气不营，邪气居之。
Qí Bó yuē: xǐ nù bù shì, shí yǐn bù jié, hán wēn bù shí, zé hán zhī liú yú cháng zhōng, liú yú cháng zhōng zé chóng hán, chóng hán zé jī jù, shǒu yú xià guǎn, zé cháng wèi chōng guō, wèi qì bù yíng, xié qì jū zhī.
岐伯说：喜怒不适，饮食不节，寒温不时，则寒汁流入肠中，流入肠中则虫寒，虫寒则积聚，守于下管，则肠胃充郭，卫气不营，邪气居之。
Qi Bo said: When joy and anger are not fitting, when food and drink are without measure, and when cold and warmth are out of season, cold juices flow into the intestines. Flowing in, they chill the worms; chilled, the worms gather and mass; keeping guard at the lower opening, they make the stomach and intestines swell outward, the guarding qi no longer nourishes, and evil qi takes up residence.
人食則蟲上食，蟲上食則下管虚，下管虚則邪氣勝之，積聚以留，留則癰成，癰成則下管約。 人食则虫上食，虫上食则下管虚，下管虚则邪气胜之，积聚以留，留则痈成，痈成则下管约。
rén shí zé chóng shàng shí, chóng shàng shí zé xià guǎn xū, xià guǎn xū zé xié qì shèng zhī, jī jù yǐ liú, liú zé yōng chéng, yōng chéng zé xià guǎn yuē.
人食则虫上食，虫上食则下管虚，下管虚则邪气胜之，积聚以留，留则痈成，痈成则下管约。
When a person eats, the worms feed upward; feeding upward, they leave the lower opening empty; empty, the evil qi overcomes it; the massing remains, and remaining, a sore forms; the sore forming, the lower opening is constricted.
其癰在管内者，即而痛深，其癰在外者，則癰外而痛浮，癰上皮𤍠。 其痈在管内者，即而痛深，其痈在外者，则痈外而痛浮，痈上皮𤍠。
qí yōng zài guǎn nèi zhě, jí ér tòng shēn, qí yōng zài wài zhě, zé yōng wài ér tòng fú, yōng shàng pí rè.
痈在管内的，即而痛深；痈在外的，则痈外而痛浮，痈上皮热。
If the sore is inside the opening, pressing it gives deep pain; if the sore is outside, the sore bulges outward and the pain is superficial, and the skin over the sore is hot.
黃帝曰：刺之奈何？ 黄帝曰：刺之奈何？
Huáng Dì yuē: cì zhī nài hé?
黄帝说：怎么刺？
The Emperor said: How should it be needled?
歧伯曰：微按其癰，視氣所行，先淺刺其傍，稍内益深，還而刺之，毋過三行，察其沉浮，以爲深淺。 歧伯曰：微按其痈，视气所行，先浅刺其傍，稍内益深，还而刺之，毋过三行，察其沉浮，以为深浅。
Qí Bó yuē: wēi àn qí yōng, shì qì suǒ xíng, xiān qiǎn cì qí bàng, shāo nèi yì shēn, hái ér cì zhī, wú guò sān xíng, chá qí chén fú, yǐ wéi shēn qiǎn.
岐伯说：轻按痈处，看气所行，先浅刺其旁，稍内益深，还而刺之，不超过三行，察其沉浮，以为深浅。
Qi Bo said: Press the sore lightly and watch where the qi goes. First needle shallowly beside it, then slightly deeper, and needle again, not more than three passes, observing whether it is sunk or floating to decide the depth.
已刺必熨，令𤍠入中，日使𤍠内，邪氣益衰，大癰乃潰。伍以參禁，以除其内，恬憺無爲，乃能行氣，後以鹹苦，化穀乃下矣。 已刺必熨，令𤍠入中，日使𤍠内，邪气益衰，大痈乃溃。伍以参禁，以除其内，恬憺无为，乃能行气，后以咸苦，化谷乃下矣。
yǐ cì bì yùn, lìng rè rù zhōng, rì shǐ rè nèi, xié qì yì shuāi, dà yōng nǎi kuì. wǔ yǐ cān jìn, yǐ chú qí nèi, tián dàn wú wéi, nǎi néng xíng qì, hòu yǐ xián kǔ, huà gǔ nǎi xià yǐ.
已刺必须温熨，使热入中，每日使热内入，邪气渐衰，大痈乃溃。用五法参禁，以除其内，恬憺无为，才能行气，后用咸苦，化谷乃下。
After needling, apply heat, so that warmth enters within; day by day let the heat go in, and the evil qi gradually declines until the great sore breaks. Take the five methods and the repeated prohibitions to clear what is within; be calm and do nothing, and only then can the qi move. Afterwards use salty and bitter, and the grain will be transformed and pass down.

Textual notes

Readings follow the base edition; significant variants are recorded here.

  1. 食晬時乃出食晬時乃出

    晬時，一周時也，即一晝夜。下膈者食入不能即下，必待一晝夜方出，與上膈之隨食隨出者相對。

  2. 則腸胃充郭則腸胃充郭

    郭讀爲廓，充郭謂脹滿外撐。蟲寒積聚守於下管，腸胃為之脹滿，衛氣不得營運，邪氣遂居其中。

  3. 守於下管守於下脘

    管讀爲脘。下管即下脘，胃之下口，蟲所守之處。全篇管、脘並見，底本一律作管，仍錄。

  4. 伍以參禁伍以參禁

    伍，參伍也；參禁，再三禁忌。謂治此者須參伍其法、謹守禁忌，非一刺可畢。此句承上刺熨之後而言。

  5. 恬憺無爲，乃能行氣恬憺無爲，乃能行氣

    恬憺，安靜也。癰潰之後，須安靜無為，使正氣自復而後氣可行。此與《素問》恬憺虛無之旨相通。

  6. 後以鹹苦，化穀乃下矣後以鹹苦，化穀乃下矣

    鹹能軟堅，苦能泄下。癰潰氣行之後，以鹹苦之味助其傳化，則穀食乃下。此下膈之善後法。

Cite this page

APA

Huangdi Neijing · Lingshu 黃帝內經靈樞 (Compiled over the same span as the Suwen; the present text was put in order in the Tang.). Shàng gé 上膈 [Above the Diaphragm], Chapter 68. In Classica Sinica Medica. Base text: 《黃帝素問靈樞經》十二卷八十一篇，宋·史崧校定并音釋。據上海涵芬樓《四部叢刊》子部影印明趙府居敬堂刊本錄入，卷首牌記題「上海涵芬樓景明趙府居敬堂刊本」，並記原書版匡高營造尺六寸三分、寬四寸四分。目錄末行作「元二十四卷今併爲十二卷計八十一篇」。底本與影印本均屬公有領域。 Retrieved 28 October 2026, from https://classicstcm.com/classics/huangdi-neijing-lingshu/above-the-diaphragm/

MLA

"Shàng gé 上膈 [Above the Diaphragm]." Huangdi Neijing · Lingshu 黃帝內經靈樞, chapter 68, Classica Sinica Medica, 2026, https://classicstcm.com/classics/huangdi-neijing-lingshu/above-the-diaphragm/. Accessed 28 Oct. 2026. Base text: 《黃帝素問靈樞經》十二卷八十一篇，宋·史崧校定并音釋。據上海涵芬樓《四部叢刊》子部影印明趙府居敬堂刊本錄入，卷首牌記題「上海涵芬樓景明趙府居敬堂刊本」，並記原書版匡高營造尺六寸三分、寬四寸四分。目錄末行作「元二十四卷今併爲十二卷計八十一篇」。底本與影印本均屬公有領域。

Chinese scholarly

《黃帝內經靈樞·上膈》（Huángdì Nèijīng Língshū）。《黃帝素問靈樞經》十二卷八十一篇，宋·史崧校定并音釋。據上海涵芬樓《四部叢刊》子部影印明趙府居敬堂刊本錄入，卷首牌記題「上海涵芬樓景明趙府居敬堂刊本」，並記原書版匡高營造尺六寸三分、寬四寸四分。目錄末行作「元二十四卷今併爲十二卷計八十一篇」。底本與影印本均屬公有領域。Classica Sinica Medica，2026 年 10 月 28 日 存取，https://classicstcm.com/classics/huangdi-neijing-lingshu/above-the-diaphragm/。

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